Does Smoking Cessation at Primary Diagnosis Reduce the Recurrence Risk of Nonmuscle-Invasive Bladder Cancer? Results of a Prospective Study

Abstract

Introduction: Evidence that smoking cessation at first diagnosis of nonmuscle-invasive bladder cancer (NMIBC) reduces the risk of recurrence is lacking. The aim of our prospective study was to analyze the association between patients' changes in smoking habits after diagnosis and recurrencefree survival (RFS). Patients: After transurethral resection of primary NMIBC, patients were classified as "ex-smokers," i.e., those definitively stopping, and as "active smokers," i.e., those continuing or restarting to smoke. Smoking status was reassessed every 3 months during the first year and every 6 months thereafter. Data on patients' demographics, smoking status, tumor characteristics, treatments, and follow-up were collected. Statistical analysis was performed adopting SPSS 15.0.1 and R3.4.2 software. Results: Out of 194 patients, 67 (34.5%) quit smoking after the diagnosis, while 127 (65.5%) did not. The clinical and pathological characteristics were homogeneously distributed. At a median follow-up of 38 months, 106 patients (54.6%) recurred, 33 (49.2%) ex-and 73 (60.3%) active smokers with a 3-year RFS of 42.3 and 50.7%, respectively (p = 0.55). No statistically significant association between recurrence, pathological features of the primary tumor, and patient smoking habits after diagnosis was detected. Results were not statistically influenced by the intensity (cigarette/day) and duration (years) of smoking. In multivariate analysis, cigarette smoking cessation at diagnosis did not significantly reduce tumor recurrence. Conclusion: In our prospective study, more than half of our patients recurred at 3 years. In multivariate analysis, smoking cessation did not significantly reduce tumor recurrence. However, the 8.4% reduction in favor of the ex-smokers suggests the need of larger studies with longer follow-ups. Surprisingly, only 35% of smokers definitively quit after diagnosis. The urologists should play a more active role to persuade the patients to stop smoking at first cancer diagnosis.

Prognostic Impact of Post-Diagnosis Smoking Cessation among Bladder Cancer Patients: A Systematic Literature Review and Meta-Analysis

“…Only nine articles were finally found eligible and included in the systematic review [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]: these were published between 1999 and 2021 and encompassed a total of 5490 BC patients (ranging across studies from a minimum of 107 to a maximum of 1733) ( Table 1 ). All studies’ mean/median age at BC diagnosis fell in the seventh or eighth decade of life.…”

Massnahmen zur Prävention und Früherkennung des Urothelkarzinoms der Harnblase

“…Somit stellt die entsprechende Aufklärung der Patienten mit neu diagnostiziertem BCa einen durchaus relevanten Punkt in der Behandlung dar. Die Risikoreduktion für ein Tumorrezidiv bei nichtmuskelinvasivem BCa nach ≥ 15 Jahren Rauchstopp ist signifikant [40]. Trotzdem schaffen es nur ungefähr 35 % der Raucher, nach der Diagnose eines BCa im Verlauf den Nikotinkonsum definitiv zu sistieren [40].…”

“…Die Risikoreduktion für ein Tumorrezidiv bei nichtmuskelinvasivem BCa nach ≥ 15 Jahren Rauchstopp ist signifikant [40]. Trotzdem schaffen es nur ungefähr 35 % der Raucher, nach der Diagnose eines BCa im Verlauf den Nikotinkonsum definitiv zu sistieren [40]. Die Wichtigkeit und Effektivität der ärztlichen Beratung im Zusammenhang mit dem Nikotinabusus und die Anbindung der Patienten an ein Rauchentwöhnungsprogramm wird unterschätzt.…”

Association of Biochemically Verified Post-Diagnosis Smoking and Nonmuscle-Invasive Bladder Cancer Recurrence Risk

“…9–11 Initial retrospective studies that examined the association between post-diagnosis smoking exposure and recurrence risk concluded that quitting smoking might reduce recurrence risk 12,13 but more recent, prospective studies did not confirm this association. 14,15…”

“…9e11 Initial retrospective studies that examined the association between postdiagnosis smoking exposure and recurrence risk concluded that quitting smoking might reduce recurrence risk 12,13 but more recent, prospective studies did not confirm this association. 14,15 To our knowledge, all prior studies on smoking and NMIBC recurrence risk have relied on self-reported smoking exposure assessments. We recently reported that biochemical verification of cotinine in urine or saliva specimens can more accurately identify patients who are actively smoking than relying on self-report.…”